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Women who have angina and report more physical symptoms are at increased risk for coronary artery disease

Research studies suggest that a smaller proportion of women with angina (crushing chest pain) have coronary artery disease (CAD) than men with angina. This may have contributed to the perception that chest pain is less serious in women. However, CAD risk is raised in certain women with angina. This is particularly true for women who have a poor cardiovascular risk profile and more physical symptoms, such as shortness of breath, concludes a study supported in part by the Agency for Health Care Policy and Research (HS06516). Specifically, the women in this study were more apt to be obese, have high blood pressure, high cholesterol, and more electrocardiogram abnormalities than women without angina, even though these factors were more weakly associated with angina than in men.

Researchers from University College London and Glasgow University used the Rose Questionnaire—the most widely used instrument to measure angina—to examine correlates of angina in younger men and women (aged 35 to 55 years). The questionnaire asked about the type, duration, and circumstances of chest pain. The researchers also asked participants about the presence of 16 different symptoms for a symptom score, as well as health behaviors such as exercise and smoking.

As expected, more females than males had angina (4 percent vs. 2.4 percent). However, there was a stronger relationship between overall symptom reporting (ranging from premenstrual irritability and bloating to shortness of breath) and angina in women than in men. The women in the top quartile of symptom reporting were also more apt to be receiving treatment for high blood pressure, and they tended to have a poor cholesterol profile. Furthermore, with few exceptions, the associations between cardiovascular risk factors and angina were significant among women in the top quartile. Angina related to CAD may be concentrated in this group of more symptomatic women, conclude the researchers.

More details are in "Rose Questionnaire angina in younger men and women: Gender differences in the relationship to cardiovascular risk factors and other reported symptoms," by Amanda Nicholson, Ian R. White, Peter Macfarlane, and others, in the Journal of Clinical Epidemiology 52(4), pp. 337-346, 1999.